There’s an issue that affects 50% of women, but nobody talks about it. It took a brave woman, a new organization, and a network of nonprofit support to break the silence.

The issue is pelvic organ prolapse (POP). While it’s been on medical record for nearly 4,000 years, there’s little awareness among the public about POP, and according to Sherrie Palm, executive director of the Association for Pelvic Organ Prolapse Support (APOPS), there’s little training among clinicians or screening for the condition.

POP occurs when pelvic floor muscles weaken and one or more organs shift out of their normal positions into the vaginal canal. There are five types of POP: bladder (cystocele), intestines (enterocele), rectum (rectocele), uterus (uterine), and vagina (vaginal vault). The two leading causes of POP are vaginal childbirth and menopause. Come to think of it, don’t lots of women give birth or go through menopause? Why don’t we all know about POP?

Breaking the Silence

That’s exactly what Sherrie Palm thought when she was diagnosed in 2008. “Why don’t I know about this?”The silence around the issue comes at least in part from the fact that POP symptoms can feel embarrassing. They include pressure and pain, urinary incontinence, urine retention, fecal incontinence, chronic constipation, painful intercourse, lack of sexual sensation, coital incontinence (leakage of urine or stool during intimacy). Not exactly dinner conversation.

Whether embarrassing or not, POP became Palm’s reality, and it turned out she wanted to talk about it. “I find it ridiculous that POP is shrouded in silence. It is health—nothing more, nothing less,” she says. “Why not help women feel empowered with choices about their bodies rather than alone and ashamed?”

“Millions of women suffer in silence with symptoms they don’t understand, often for years, sometimes decades, before they’re diagnosed. There’s no POP screening during routine pelvic exams, which is ridiculous considering childbirth is the number one cause and the number two cause is menopause (there are many other causes as well). Also diagnostic clinicians (primary care and gynecology) are poorly educated on POP, which is absurd considering the prevalence is estimated to be half the female population,” says Palm. “Someone has to generate change.”

And that’s exactly what she did.

Getting Help from NPC

“I started my advocacy path by writing a book about POP. Then, about 15 months into marketing my first edition, the light bulb came on. In order to effectively help women, I should found a nonprofit. The realization shifted my entire path.”

Enter the Nonprofit Center of Milwaukee (NPC). When Sherrie shifted her focus from a book to full-fledged advocacy through a nonprofit, she started using the classes and consulting available from NPC.

“Working with NPC built the bricks that built the walls of our structure,” she reflects. Palm recruited Susanne Vella, training coordinator at NPC, to be on her board. “She’s an amazing resource with all kinds of information based on her many years in the sector combined with her amazing compassionate heart,” says Palm.

APOPS is staffed by eight volunteers who spend part of their time managing a closed Facebook support group. The organization also has a volunteer intern and several other volunteers who assist at events. APOPS has become a voice being heard in every state and around the world. They’ve moved from being the dream of a recently diagnosed patient to a global voice empowering women with POP and equipping medical professionals to better serve them.

The Networking Effect

While she values the classes she’s taken at NPC—first on nonprofit startup, governance, and management, then clarifying the vision, communicating value to potential supporters, and building a board—Palm says the greatest value has been “the networking effect”: “You not only learn from the teachers (all experts in their topics), but also from every attendee. For me, being connected to other women’s health organizations is of value.”

APOPS will hold its second walkathon, STIGMA#STRIDE, on June 5 at Greenfield Park. The inaugural APOPS 2016 Women’s Pelvic Health Congress will occur this August in Milwaukee and in Manchester, England. The event, which provides a POP curriculum for diagnostic clinicians, is planned to occur annually both in the US and abroad. “We are every woman,” says Palm about POP. The condition can occur from late teens through mid-80s and affects every physical, emotional, social, sexual, financial, educational, racial, nationality, employment, or fitness demographic you can think of.

As the silence is slowly broken, a loving, supportive tribe of women in APOPS waits for us, acting as a gentle wave of empowerment.

Hannah Weinberg-Kinsey is a Masters candidate in Education at Alverno College and a Reading Corps volunteer, in its inaugural year in Milwaukee, at Gwen T. Jackson Early Education and Elementary School.

I’ve been thinking a lot about nonprofit governance—specifically, the relationship between board and executive—for a couple of reasons.

First, I’ve been preparing to teach a series of workshops on governance here at the Nonprofit Center of Milwaukee. I’ve taught the series many times before, and this time, the theme that unifies the sessions will most likely be the balance between governance and administration, board and agency executive in particular.

Second, I’m in a new role as I teach this series, as the CEO of NPC, where the board just elected a new set of officers and voted in several new directors—all of them nice choices. Now, instead of working on a board-executive relationship from the outside, as a consultant, I’m on the inside, as a part of that relationship. I’ll admit, it feels very different.

Between the two different roles, I’ve been able to make some observations and draw some conclusions about what makes the board-executive relationship workable:

There is no ideal balance between the executive and the board. As the old adage goes, if you've seen one board you've seen one board. They’re all different, based on the maturity of the organization and the nature of the people who sit around the board table and behind the executive’s desk.

And that balance changes across time, because the organization’s governance is and will always be transitory. While the staff charged with implementing programs and achieving goals change little year by year, board directors—who take on the role of providing leadership, oversight, and support—change almost every year. As new directors are added, directors cycle off, and new officers are elected, the relationship with the executive will change.

I have a new board to work with, essentially, with new people in the various officer roles, and four new directors replacing two who cycled off. Though I was hired by one board, I’m now going to need to build relationships with a group of a different composition and figure out how we can all work best together.

Over many years as a consultant to nonprofits, I’ve seen the gamut of styles of board engagement, from not enough (completely disengaged) to way too much (micromanaging). I’ve also seen executives who want too much help (asking permission for everything they did) as well as those who want no help at all (“this is my organization, and the board just gets in the way”).

What I’ve learned is that some dysfunction in the relationship between the executive and the board is normal. In one or two cases I can recall, the relationship between board and executive looked very dysfunctional when compared to what is considered ”best practice” — but it actually worked for them and the organization was moving along smoothly and running some very good and impactful programs. As a consultant, I had to say, “It ain't broke, so I won't fix it.”

That’s because a board-executive relationship can bear some dysfunction if all parties have the same expectations. The biggest cause of conflict between boards and executives is differing and unspoken expectations of the relationship. As an executive, you have to have a board that you can work with and get along with and vice versa—you need to learn how to work with your board. You need to be a team, and both parties need to want that. Articulating what you expect of yourself and each other in that regard goes a long way toward reducing and eliminating sources of conflict.

The issue is to find the relationship that works for you and your organization. Be intentional about it—my governance series theme from last year. As the new officers take the reins, particularly the president, there should be a meaningful conversation about how this year is going to go, how you are going to work together, and what you want and need from each other.

By Guest Blogger Robert Meiksins, Forward Steps ConsultingHaving just completed teaching a series of five workshops on governance at the Nonprofit Center, I discovered almost by accident an emerging theme that captures what I believe to be a major difference between boards that are effective and those that are asleep at the wheel (and yes, there are many gradations between those extremes).

The theme is "intentional governance."A board that is practicing intentional governance is a group of directors that are thinking. A board of directors that is not governing intentionally behaves a certain way simply because "that's the way we do things," or because they think that's how a board is supposed to behave.

Being intentional means you are not doing something by rote. To govern effectively means acting with a reason in mind, a purpose that will help provide the appropriate levels of oversight, leadership, and support that a board should give the organization in its care.This intentional governance can play out in any number of ways, but it always involves having eyes open. In recruitment, for example, it means moving beyond having the board directors ask each other, "Do you know anyone who might do this?" That may do nothing but simply fill an empty board seat with people who, more than likely, will attend meetings on an irregular basis, won’t make a contribution, and certainly won’t help write a strategic plan.

Back when I was in theater, we used to call it the “warm body school of casting.” As long as they could move and talk, they had the role. A board that is acting intentionally will go to whatever strategic, annual, or business plan is in place and identify the skills, attributes, personality traits, and connections that are needed to accomplish the adopted goals. These, then, become the rubric to help identify the candidates to look for when recruiting to the board, directors that will have a real impact and help the organization move forward.When developing and adopting a budget, the intentional board will work with staff to analyze how things have worked over the past few years. If we have invested X dollars in our programs, have we met our goals? If so, great - if not, why not? In either case, if we invest more, will we do better? The intentional Board will also work with staff to analyze if the budget is being allocated appropriately to fulfill the organization's mission: are there elements of what we want to do that need more attention? An intentional board will also ask the staff if there are any emerging trends that the organization should devote some financial resources to in the coming years.

My final example is about how board and committee meetings are managed. An intentional board will never, ever, ever have an agenda that looks exactly like the last one or the one before it. The chair and the executive director should talk before hand and decide what needs to be decided at this meeting, and structure the agenda accordingly.

At the workshops I taught at the Nonprofit Center, we talked about acting intentionally around fund development, board development, oversight issues, and much more. Every time we shared a story about some dysfunction we had seen, it could be traced to a board that was sleepwalking or acting like they had walked off the set of Invasion of the Body Snatchers with blank, mindless stares. OK, I may be exaggerating there, but you get the point. A good board governs intentionally, with eyes open, and with the organization's clients, mission, and goals clearly in mind.

Let me hear from you. Do you have a story that illustrates this idea of intentional governance?

“What if true governance called for the board to make the choices that create the future for the communities they serve?” TerrieTemkin prefers this approach by Steve Bowman.

“To lead profound change is to shift the inner place from which a system operates. This can be done only collaboratively.” - Otto Scharmer

by Margaret Thom, Membership Manager, Nonprofit Center of Milwaukee

Building an active, strategically oriented board of directors is the most common challenge facing nonprofits according to a recent national survey. The board of directors carries responsibility for not only an organization’s fiscal and legal well-being, but also its mission and identity -- past, present and future. While this service is essential, nonprofit board development often comes after more urgent priorities.What is governance? What is good governance? Terrie Temkin, editor of the book You and Your Nonprofit Board, tackles the topic in this excellent, readable collection of articles written by nonprofit governance experts with various perspectives.

Visionary board leadershipFrank Martinelli, of The Center for Public Skills Training and contributor to You and Your Nonprofit Board, writes and presents on encouraging visionary board leadership. He cites three modes of board governance from Governance as Leadership:

Fiduciary Mode Principal role: Sentinel

Strategic Mode Principal role: Strategist

Generative Mode Principal role: Visionary

Given constant change, for the long-term health of the organization, Martinelli and others argue for a nonprofit board to be visionary, as well as fiduciary and strategic.

Be sure to engage board members in strategic and generative thinking focused on the future, as well as reviewing reports of what’s happened.

Bundle routine items in a consent agenda to free up time for discussion.

Schedule time for strategic deliberation into every meeting.

Make board development continuous, cycling through the three stages of assessment, action planning and plan implementation.

Sensing not seeingThe generative mode of governance requires sensing not seeing: What are our new possibilities? What’s coming? What are the important new questions? For guidance in this area, see the book Presence: Exploring Profound Change in People, Organizations, and Society by the Society for Organizational Learning. Otto Scharmer, one of the authors, guides one along a path of presencing to sense the future in Theory U: Leading from the Future as It Emerges. He writes, “To lead profound change is to shift the inner place from which a system operates. This can be done only collaboratively.” He asks, “What are the principles and practices that will help me and others to link with and realize our best future possibility?” and answers with the Five Movements of the U Process:

Co-initiating: Listen to others and to what life calls you to do

Co-sensing: Go to the places of most potential and listen with your mind and heart wide open

Co-presencing: Retreat and reflect, allow the inner knowing to emerge

Co-creating: Prototype a microcosm of the new to explore the future by doing

Co-evolving: Grow innovation ecosystems by seeing and acting from the emerging whole

Quality conversation Generative thinking also requires quality conversation. Temkin writes, “quality conversation is the heart of governance. … A lot of people are looking at the impact quality conversations are having on the ability to govern - a topic rarely even mentioned a couple years ago.” Interesting.

Does the board serve the same role for a nonprofit as the heart serves for the human body? The heart senses everything that flows through it, gleans what’s happening throughout the body, and is a center of innate bodily intelligence, striving to balance the whole. It’s also the keeper of our deepest feelings and sense of identity.

How can we develop the capacity to think and know with our heart?

As Donna Shepard, of the UWM Center for Diversity Learning, said at her keynote for the 2014 Evolving Leaders Conference, “Before I can affect change, I have to work on myself.”

BibliographyGovernance as Leadership:Reframing the Work of Nonprofit Boards, Richard Chait, William Ryan and Barbara Taylor, BoardSource Presence: Exploring Profound Change in People, Organizations, and Society by Peter Senge, C. Otto Scharmer, Joseph Jaworski, and Betty Sue Flowers of the Society for Organizational Learning, published by Currency, DoubledayTheory U: Leading from the Future as It Emerges, C. Otto Scharmer, published by Society for Organizational LearningYou and Your Nonprofit Board: Advice and Practical Tips from the Field’s Top Practitioners, Researchers, and Provocateurs, In the Trenches Series, edited by Terrie Temkin, PhD, Charity Channel Press.

By Guest Blogger Robert Meiksins, Forward Steps Consulting LLCGovernance expert Rob Meiksins answers your questions about nonprofit Boards, executive leadership, fund development, strategic planning, and other nonprofit consulting issues. Today’s topic: Role of the Executive Committee. To start this blog about nonprofit governance, I would like to extend my thanks to those of you serving as Board Directors. You probably don’t hear that very often, so let me say it again: thank you. Every day we are touched by nonprofits: schools, hospitals, soccer clubs, even the place where we drop off our unneeded clothes and furniture. Many of us enjoy the entertainment provided by nonprofits arts groups. Too many have to rely on the safety net social service nonprofits provide. In Milwaukee County there are more than 5,500 nonprofits with combined revenue of more than $15 billion. This is not a small portion of our economy, and the Board Directors in those 5,500 organizations are the ones who assume the legal and fiscal responsibility: they are the bottom line. Unfortunately we spend far too little time talking to and about these wonderful people. We spend even less time helping them. So, thank you again to all Board Directors. You are doing the single most philanthropic thing possible in our society. You are choosing to give of your time, talent, and treasure to make sure that nonprofits are working effectively and efficiently, and using our investments well.To support you in your service, I offer this blog as an advice column for Board Directors. I’ll discuss trends and issues that I see. But feel free to send me questions at robm@fwdsteps.com. I’ll try to answer them, and if a question might resonate for other people, I’ll post the answer in this blog. Here is an example of the kind of topic we can cover. Recently I was asked about the role an Executive Committee should play. The answer I gave was not popular: consider not having one at all. Executive Committees, the most common committee, are intended to meet between Board meetings, and authorized to take action on behalf of the Board. This can help because a small committee of 5 people (usually the Board Officers) is easier to call together than a large Board (average size is 16 Directors). In an emergency, or when an opportunity arises, the Executive Committee can meet and make a decision quickly and easily. The negative, however, is that a small group of people have now made a decision that has an impact on every Board Director. As we noted, the Executive Committee often has 5 members, the Officers of the Board, so quorum is 3. To approve a decision and take action, a simple majority is required, which means that only 2 people attending need to agree. Two people have taken action that all 16 Board Directors are now responsible for. That does not seem fair.In Wisconsin, the state statutes allow a Board to take action outside of a meeting by voting with email. Since this is so easy and allows all Directors to have their say, why have an Executive Committee? The most common cause for a disengaged Board is the Executive Committee has been given too much power and has become the main decision-making body. Some Executive Directors like it because it is easier to get a decision made. But the other Board Directors correctly feel that decisions are being made without their input and wonder why they are there at all and they stop showing up or paying attention. So, consider not having an Executive Committee. Thanks for reading. I hope you have enjoyed this blog and look forward to hearing from you with your questions. Remember to register for my governance workshop series at the Nonprofit Center this summer.